Provider Demographics
NPI:1528213246
Name:NATIONAL SPECIALITY PHARMACY LLC
Entity Type:Organization
Organization Name:NATIONAL SPECIALITY PHARMACY LLC
Other - Org Name:PEN MILL PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NINO
Authorized Official - Middle Name:
Authorized Official - Last Name:CARNOVALE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-791-6700
Mailing Address - Street 1:1336 PENINSULA BLVD
Mailing Address - Street 2:
Mailing Address - City:HEWLETT
Mailing Address - State:NY
Mailing Address - Zip Code:11557-1226
Mailing Address - Country:US
Mailing Address - Phone:516-791-6700
Mailing Address - Fax:516-791-8324
Practice Address - Street 1:1336 PENINSULA BLVD
Practice Address - Street 2:
Practice Address - City:HEWLETT
Practice Address - State:NY
Practice Address - Zip Code:11557-1226
Practice Address - Country:US
Practice Address - Phone:516-791-6700
Practice Address - Fax:516-791-8324
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-21
Last Update Date:2012-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 3336C0004X, 3336S0011X
NY0291563336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03047174Medicaid
3360726OtherNCPDP PROVIDER IDENTIFICATION NUMBER
3360726OtherNCPDP PROVIDER IDENTIFICATION NUMBER